Washer for supporting cable relative to bone

ABSTRACT

A washer for supporting a through-bone cable extending through a pass-through hole in bone includes a bone-engaging surface, a cable-engaging surface opposing the bone-engaging surface, a pass-through aperture extending through the washer along a first axis from the bone-engaging surface to the cable-engaging surface, and a channel extending from proximate the pass-through aperture along a second axis where the second axis is non-parallel to the first axis.

FIELD

The subject matter of the present disclosure relates generally to washers for supporting a cable relative to bone. More specifically, the present disclosure relates to using a cable washer to support a cable extending from a pass-through hole in a bone or from around a bone.

BACKGROUND

Various medical procedures utilize cables or conventional sutures to secure damaged skeletal tissue or soft tissue. Tissues, such as bones or soft-tissues, that have been fragmented, fractured, broken, torn, pulled, stretched, or otherwise damaged need to be set and held in specific orientations in order to properly heal. Cables or conventional sutures may be useful for stabilizing or connecting torn tissue back together or for facilitating holding bone fragments in place. For example, cerclage cables or conventional sutures can be wrapped around or lie adjacent to bone for fracture reduction, fracture fixation, and crack propagation prevention. However, conventional tools and procedures for utilizing cables or conventional sutures in medical surgeries are generally time-consuming, complex, and usually involve multiple in-situ steps that are difficult to perform.

SUMMARY

From the foregoing discussion, it should be apparent that a need exists for an apparatus, system, and method for fracture reduction, fracture fixation, and crack propagation prevention that overcome the limitations of conventional medical tools and procedures. Beneficially, such an apparatus, system, and method would improve the ease, efficiency, and effectiveness of medical procedures for fracture reduction, fracture fixation, and crack propagation prevention.

The subject matter of the present application has been developed in response to the present state of the art, and in particular, in response to the problems and needs in the art that have not yet been fully solved by currently available medical tools and procedures. For example, the ease, efficiency, and effectiveness of fracture reduction, fracture fixation, and crack propagation prevention is improved by passing the cable through a bone via a drilled hole (or a reamed hole, cut hole, etc.) in the bone and using one or more washers to support the cable. Accordingly, the present disclosure has been developed to provide an apparatus for supporting a through-bone cable extending from a pass-through hole in a bone, and its related systems and methods, that overcome many or all of the above-discussed shortcomings in the art.

Disclosed herein is one embodiment of a washer for supporting a through-bone cable extending through a pass-through hole in a bone. The washer includes a bone-engaging surface, a cable-engaging surface opposing the bone-engaging surface, a pass-through aperture extending through the washer along a first axis from the bone-engaging surface to the cable-engaging surface, and a channel extending from proximate the pass-through aperture along a second axis. The second axis is at least one of non-parallel to or offset from the first axis.

In one implementation, a first portion of the cable is extendable through the pass-through aperture and a second portion of the cable is extendable through the channel. In another implementation, at least a portion of the channel is circumferentially closed. The washer may include multiple channels extending from proximate the pass-through aperture along different axes, each axis being at least one of non-parallel to or offset from the first axis. For example, the washer may have at least three channels extending from proximate the pass-through aperture along different axes, each axis being at least one of non-parallel to or offset from the first axis. In another example, the washer has at least four channels extending from proximate the pass-through aperture along different axes, each axis being at least one of non-parallel to or offset from the first axis.

In one implementation, the pass-through aperture has a substantially non-circular cross-section (e.g., lobed shape). In one implementation, the bone-engaging surface and the cable-engaging surface are substantially parallel. In another implementation, the bone-engaging surface is contoured to complement a contour of a bone (e.g., shaped to complement the equator of a bone). In yet another implementation, an angle between the second axis and the first axis is less than 45 degrees. For example, the angle between the second axis and the first axis may be substantially about 30 degrees. The washer may have a footprint that is non-circular, with the washer having an arm extending outward away from the pass-through aperture. The channel extends from proximate the pass-through aperture through the arm.

In one implementation, the channel forms a continuous circumferentially closed passage from the pass-through aperture and extends to a peripheral edge of the cable-engaging surface. In another implementation, the washer includes a protruding lip at a peripheral edge of the cable-engaging surface, with the protruding lip extending away from the cable-engaging surface. The protruding lip may circumferentially enclose at least a portion of the channel. In one implementation, the circumferentially closed portion of the channel is compressible to crimp the cable.

Also disclosed herein is one embodiment of a washer for supporting a cable extending through bone. The washer includes a bone-engaging surface, a cable-engaging surface opposing the bone-engaging surface, a pass-through aperture extending through the washer along a first axis from the bone-engaging surface to the cable-engaging surface, and a channel extending from proximate the pass-through aperture along a second axis that is at least one of non-parallel to or offset from the first axis. In some implementations, a first portion of the cable is extendable through the pass-through aperture and a second portion of the cable is extendable through the channel. A footprint of the washer is non-circular and the washer further includes an arm extending outward away from the pass-through aperture, with the channel extending from proximate the pass-through aperture through the arm. At least a portion of the channel is circumferentially closed.

According to one implementation, an angle between the second axis and the first axis is less than 45 degrees. In another implementation, the angle between the second axis and the first axis is substantially about 30 degrees. In another embodiment, the angle between the first and second axes is greater than 45 degrees. In yet another embodiment, the first and second axes may be parallel but offset from each other.

Disclosed herein is one embodiment of a method of using a washer to support cable extending from bone. The method includes positioning the washer over the hole in the bone such that the bone-engaging surface of the washer engages the surface of the bone adjacent the hole. The method further includes passing the cable through the hole in the bone and through the pass-through aperture in the washer extending along a first axis from the bone engaging surface to a cable-engaging surface. Still further, the method includes positioning the cable in the channel of the washer with the channel extending along a second axis that is at least one of non-parallel to or offset from the first axis.

In one implementation, positioning the cable in the channel includes passing the cable through a circumferentially closed portion of the channel. In such a configuration, the method may further include crimping the cable in the circumferentially closed portion of the channel. In another implementation, the method may also include tensioning the cable to a measurable and adjustable tension, to cause a measurable and adjustable compression of the bone by the cable, after passing the cable through the hole in the bone and after positioning the cable in the channel of the washer.

According to another embodiment, a method of extending a cable through a pass-through hole in bone includes passing a cable through the pass-through hole in the bone, wherein the cable is pre-attached to a stop. The method also includes tensioning the cable to a measurable and adjustable tension to cause a measurable and adjustable compression of the bone by the cable. Before tensioning the cable, the method may include positioning a washer over the pass-through hole in the bone such that a bone-engaging surface of the washer engages a surface of the bone adjacent the pass-through hole, and passing the cable through a pass-through aperture in the washer, the pass-through aperture extending from the bone-engaging surface to a cable-engaging surface. The method can include seating the stop against a complimentary shape of the cable-engaging surface of the washer. The stop can be a washer and the method may also include redirecting one or more additional cables or an opposite end portion of the cable along a cable-engaging surface of the washer.

Reference throughout this specification to features, advantages, or similar language does not imply that all of the features and advantages that may be realized with the present disclosure should be or are in any single embodiment of the disclosure. Rather, language referring to the features and advantages is understood to mean that a specific feature, advantage, or characteristic described in connection with an embodiment is included in at least one embodiment of the subject matter disclosed herein. Thus, discussion of the features and advantages, and similar language, throughout this specification may, but do not necessarily, refer to the same embodiment.

Furthermore, the described features, advantages, and characteristics of the disclosure may be combined in any suitable manner in one or more embodiments. One skilled in the relevant art will recognize that the subject matter of the present application may be practiced without one or more of the specific features or advantages of a particular embodiment. In other instances, additional features and advantages may be recognized in certain embodiments that may not be present in all embodiments of the disclosure. Further, in some instances, well-known structures, materials, or operations are not shown or described in detail to avoid obscuring aspects of the subject matter of the present disclosure. These features and advantages of the present disclosure will become more fully apparent from the following description and appended claims, or may be learned by the practice of the disclosure as set forth hereinafter.

BRIEF DESCRIPTION OF THE DRAWINGS

In order that the advantages of the disclosure will be readily understood, a more particular description of the disclosure briefly described above will be rendered by reference to specific embodiments that are illustrated in the appended drawings. Understanding that these drawings depict only typical embodiments of the disclosure and are not therefore to be considered to be limiting of its scope, the subject matter of the present application will be described and explained with additional specificity and detail through the use of the accompanying drawings, in which:

FIG. 1A is a top perspective view of a washer for supporting a cable extending from a hole in a bone, with the washer having a pass-through aperture and a channel, according to one embodiment;

FIG. 1B is a top perspective view of another embodiment of the washer for supporting a cable extending from a hole in a bone, with the washer having a non-circular pass-through aperture;

FIG. 1C is a side view of the washer of FIG. 1A, according to one embodiment;

FIG. 1D is a side view of the washer, with the washer having a contoured bone-engagement surface complimentary to the shape of a bone, according to one embodiment;

FIG. 2A is a top perspective view of the washer, with the washer having two channels, according to one embodiment;

FIG. 2B is a side view of the washer of FIG. 2A, according to one embodiment;

FIG. 2C is a side view of the washer of FIG. 2A showing a first portion of the cable having an affixed stop that seats against the cable-engaging surface of the washer; according to one embodiment;

FIG. 2D is a schematic side view of a stop having a cable pre-attached to the stop;

FIG. 3 is a top perspective view of the washer, with the washer having three channels, according to one embodiment;

FIG. 4A is a top perspective view of the washer, with the channel of the washer being a groove in the cable-engaging surface extending to a peripheral edge of the washer, according to one embodiment;

FIG. 4B is a top perspective view of the washer, with a portion of the channel of the washer being circumferentially closed, according to one embodiment;

FIG. 5 is a schematic flowchart diagram of a method using the washer to support a cable extending from a hole in a bone; and

FIG. 6 is a schematic flowchart diagram of one embodiment of a method for extending a cable through a pass-through hole in a bone.

DETAILED DESCRIPTION

Reference throughout this specification to “one embodiment,” “an embodiment,” or similar language means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment of the present disclosure. Thus, appearances of the phrases “in one embodiment,” “in an embodiment,” and similar language throughout this specification may, but do not necessarily, all refer to the same embodiment. Similarly, the use of the term “implementation” means an implementation having a particular feature, structure, or characteristic described in connection with one or more embodiments of the present disclosure, however, absent an express correlation to indicate otherwise, an implementation may be associated with one or more embodiments.

In the following description, numerous specific details are provided. One skilled in the relevant art will recognize, however, that the subject matter of the present application may be practiced without one or more of the specific details, or with other methods, components, materials, and so forth. In other instances, well-known structures, materials, or operations are not shown or described in detail to avoid obscuring aspects of the disclosure. Also, like reference numbers (e.g., 112 and 212) refer to like components (e.g., different embodiments of the same component).

Illustrated in FIGS. 1A-4B are several representative embodiments of a washer for supporting a cable extending from a hole (e.g., a tunnel, passage, or passageway) in a bone, As described herein, the washer for supporting the cable provides various advantages and benefits over other medical tools and procedures. However, the recited advantages are not meant to be limiting in any way, as one skilled in the art will appreciate that other advantages may also be realized upon practicing the present disclosure.

FIG. 1A is a top perspective view of the washer 100 for supporting a cable 120 extending from a hole 51 in a bone 50, according to one embodiment. The washer 100 includes a bone-engaging surface 103 and a cable-engaging surface 110 opposing the bone-engaging surface 103. The washer 100 further includes a pass-through aperture 106 extending through the washer 100 and a channel 112 extending through the washer 100. The extension direction of the pass-through aperture 106 is along a first axis 107 (FIG. 1C) and the extension direction of the channel 112 is along a second axis 113 that is at least one of non-parallel to or offset from the first axis 107. In one embodiment, the channel 112 extends from a location proximate the pass-through aperture 106. The pass-through aperture 106 of the washer 100 in FIG. 1A has a substantially circular cross-section. According to another embodiment, as depicted in FIG. 1B, the pass-through aperture 106 of the washer 140 has a non-circular cross-section. For example, sidewalls 145 of the pass-through aperture 106 can form a lobed-shape (e.g., three lobes), thus allowing greater flexibility when positioning the washer 140 over the hole 51 in the bone 50.

The washer 100 is configured to be positioned directly adjacent (e.g., abutting) the bone 50 so as to cover the hole 51 in the bone 50. For depiction clarity, the washer 100 in FIG. 1A is shown a distance removed from the bone 50, but directional arrows indicate how the washer 100, during use, will be positioned to directly contact the surface of the bone 50 proximate the hole 51. The cable 120 extends from the hole 51 and passes through the pass-through aperture 106, across the cable-engaging surface 110, and through the channel 112. A first portion 121 of the cable 120 is disposed in the pass-through aperture 106 and a second portion 122 of the cable 120 is disposed in the channel 112. In this manner, the washer 100 is configured to redirect the cable 120 after extending out from the hole 51.

As defined herein, the term “cable” refers to a cord-like element, such as a wire, filament, weave, or thread, whether bundled or individual, that is capable of holding a measurable and adjustable tension and causing a measurable and adjustable compression of bone. In other words, the tension in the cable can be measured, such as by a tension measuring device, and can be adjusted, such as after an initial tensioning of the cable. When used to compress bone (e.g., to compress two bone segments together), the measured tension in the cable is equal to a measured compression of the bone. Thus, as used herein, a measured and adjustable tension of a cable is synonymous with a measured and adjustable compression of bone by the cable.

In one embodiment, the measurable and adjustable tension may be a specific, known, predictable, expected, controllable, anticipated, desired, repeatable, sustainable, and/or predeterminable tension. For example, the cable 120 may be passed through a pass-through hole in a bone and may be tensioned to a measurable and adjustable tension in order to facilitate the reduction and fixation of fractures or to otherwise facilitate the repair of dislocations or soft-tissue damage. In other words, the cable 120 is not a conventional suture or conventional thread material, since such materials are incapable of, or at least not well-suited for, maintaining a measurable and adjustable tension. Thus, the term “cable” refers to a flexible yet substantially non-stretchable element that can be tensioned to a measurable and adjustable tension. Because the cable 120 is capable of maintaining or retaining a measurable and adjustable tension, the effectiveness and reproducibility of successful surgical procedures is improved. In other words, different surgical procedures relating to different bones in the body may involve different degrees of retention/fixation force (e.g., the fixation force required to reduce a fracture in the femur may be greater than the fixation force required to reduce a fracture in the patella). Accordingly, the ability of the cable 120 to be tensioned to a measurable and adjustable tension improves the reliability and reproducibility of surgical procedures when compared with other medical procedures that do not utilize cables. The cable 120 may be made from any one of various materials. For example, in specific implementations, the cable 120 is made from metal, such as stainless steel, titanium, or other metal.

As introduced above in the Background section, cables can be used to suture torn tissue back together and/or to hold bone fragments securely in place. For example, one end of a cable may be anchored to a bone while the other end of the cable is wrapped around the bone to provide external reinforcement after the fractured bone has been set (e.g., a cerclage configuration). In another example, a cable may be used to couple the bone to a soft-tissue segment or to another bone. The washer 100 described herein is specifically configured to engage and support a cable 120 as it changes directions upon extending from a hole 51 in a bone 50. In other words, the washer 100 facilitates a change in the direction of the cable 120 by mitigating wear and damage to the bone 50 that would otherwise occur if the washer 100 were not employed. Also, cables may be tensioned in order to adequately hold the various tissues in place. Accordingly, if the washer 100 was not employed to cover the hole 51, the tensioned cable, extending in a different direction upon exiting the hole 51, would potentially cut into the edge of the bone defining the hole 51, causing the patient to experience pain and/or causing the surgery to be compromised as the cable loses tension, cuts through the bone, or fractures the bone. In other words, the washer 100 prevents the cable 120 from directly contacting and potentially damaging the edge of the hole 51 in the bone 50 and also engages the cable 120 within the channel 112 to direct and retain the cable 120 in a desired direction (e.g., across the surface of the bone).

In order for the cable 120 to be tensioned, the opposing end of the cable (e.g., the end of the cable that extends into the hole 51 of the bone 50) must be anchored or securely retained. In one embodiment, the cable 120 is coupled to a bone anchor that has been installed in the hole 51 or on an opposite side of the bone 50. In another embodiment, the opposing end of the cable 120 has a stop, such as a crimp body, that is engageable with the opposing surface of the bone proximate the opposite opening of the hole, thus preventing the cable 120 from sliding through the hole in the bone 50 and thereby ensuring that the cable 120 remains securely anchored.

In another embodiment, two separate cables 120A, 120B (depicted as dashed lines) each extends through a respective one of the pass-through aperture 106 and the channel 112. In such an embodiment, to retain the cables 120A, 120B in place relative to the washer 100, a crimp body (not shown) may be crimped to each of the cables 120A, 120B. The crimp body can be configured to engage the cable-engaging surface 110 of the washer 100 (e.g., nestably engage or be seated onto the cable-engaging surface 110), thereby retaining the cables 120A, 120B in place relative to the washer 100. In one implementation, the cable 120B is retained on the washer 100 and extends through the hole 51 in the bone 50, and the cable 120A is retained on the washer 100 and extends around (e.g., to cerclage) the bone 50. In yet another implementation, one end of a cable can extend through the hole 51 in the bone 50 and the pass-through aperture 106, and be retained to the washer 100 by a crimp body, and another end of the same cable can wrap around the bone 50, pass through the channel 112, and be retained to the washer 100 by a separate crimp body.

As described above, the pass-through aperture 106 of the washer 100 extends along the first axis 107 and the channel 112 extends along the second axis 113. The channel 112 is specifically configured to direct the cable 120 in a specific direction and prevent the cable from inadvertently slipping laterally across the surface of the bone 50.

According to the depicted embodiment, the first and second axes 107, 113 are non-parallel. In one embodiment, the first axis 107 is perpendicular to the second axis 113. In another embodiment, a minor angle between the first axis 107 and the second axis 113 is less than 45 degrees. In yet another embodiment, the minor angle between the first axis 107 and the second axis 113 is about 30 degrees. In another embodiment, the angle between the first axis 107 and the second axis 113 may be dependent on the configuration and dimensions of the bone (e.g., the angle between the first and second axes may be greater than 90 degrees).

As described above, the pass-through aperture 106 and the channel 112 extend along the first axis 107 and second axis 113, respectively. The washer 100 may be configured to have a specific angle between the first and second axes 107, 113 that corresponds with the specific dimensions of the bone 50 and that corresponds with the desired extension direction of the cable 120 after it exits the hole 51 of the bone 50. Nevertheless, despite a practitioner's intent to match the desired extension direction of the second portion 122 of the cable 120 with the second axis 113 of the channel 112, the direction of the cable and the second axis 113 may not be parallel. In other words, the extension directions of the first and second portions 121, 122 of the cable 120 are not necessarily parallel with the first and second axes 107, 113 of the pass-through aperture 106 and the channel 112. For example, the first portion 121 of the cable 120 may extend at an angle relative to the first axis 107 through the pass-through aperture 106 and/or the second portion 122 of the cable 120 may extend at an angle relative to the second axis 113 of the cable 120 through the channel 112. The extent of the offset between the extension direction of the cable and the first and second axes may be based on the relative sizes of the diameter of cable 120 and the cross-sectional dimensions of the pass-through aperture 106 and channel 112.

The cable-engaging surface 110 is the portion of the washer 100 upon which the cable 120 is directly engaged as it transitions between the pass-through aperture 106 and the channel 112. The cable-engaging surface 110 may be smooth and/or have rounded edges and corners to prevent wear on the cable 120. In one embodiment, as described in greater detail below with reference to FIGS. 4A and 4B, the cable-engaging surface 110 may have a groove that further facilitates the proper and secure engagement between the cable 120 and the washer 100.

The bone-engaging surface 103, opposite the cable-engaging surface 110, is the portion of the washer 100 that directly contacts the bone 50. In one embodiment, the cable-engaging surface and the bone-engaging surface are substantially parallel. In another embodiment, the bone-engaging surface 103 is substantially coplanar. In yet another embodiment, the bone-engaging surface 153 may be specifically shaped and designed to conform to and/or complement the surface shape of the bone 50 upon which it is engaged. For example, the side view of the washer 150 in FIG. 1D shows the bone-engaging surface 153 having undulations or indents that correspond with a specific shape of the bone against which the washer 150 will be positioned.

The footprint of the washer 100, according to the depicted embodiments, is non-circular. In other words, the washer may include an arm 114 extending radially outward away from a main body 101 of the washer, through which the pass-through aperture 106 extends, with the channel 112 extending from proximate the pass-through aperture through the arm 114. Also, according to the depicted embodiment, at least a portion of the channel 112 is circumferentially closed. In another embodiment, the channel may be open (i.e., only partially circumferentially closed) as described in greater detail below with reference to FIGS. 4A and 4B.

FIGS. 2A-3 show various embodiments of the washer having multiple channels. More specifically, FIGS. 2A and 2B show a top perspective view and a side view, respectively, of one embodiment of the washer 200 with two channels 212A, 212B while FIG. 3 shows a top perspective view of the washer 300 with three channels 312A, 312B, 312C.

The washer 200 in FIGS. 2A and 2B has the pass-through aperture 206 disposed in between the two arms 214A, 214B, each arm having one of the channels 212A, 212B. In one embodiment, the two axes 213A, 213B of the channels 212A, 212B extend in mirror image directions (i.e., both angles are the same relative to the first axis 207 of the pass-through aperture 206). In another embodiment, however, the two axes 213A, 213B of the channels 212A, 212B extend in different directions relative to the first axis 207 of the pass-through apertures 206. In other words, the first channel 212A on the first arm 214A of the washer 200 may be configured to extend the cable in a direction, relative to the first axis 207, that is different than the second channel 212B in the second arm 214B of the washer 200 based on the specific dimensions and shape of the bone 50.

FIG. 2C is a side view of the washer 200 of FIG. 2A showing a first portion 123 of the cable 120 having a stop 146 affixed to an end of the cable 120. The stop 146 is configured to seat against the cable-engaging surface 210 of the washer 200. The direction arrows in FIG. 2C show the direction the cable 120 is pulled through the pass-through aperture 206 of the washer 200 to move the stop 146 into seated engagement with the washer 200. After a portion of the cable is passed through the pass-through aperture 206 of the washer 200, the portion of the cable 120 may be passed through a hole in the bone and/or wrapped around bone. A pulling force may be exerted on the cable 120 to tension the cable 120 to a measureable tension. Furthermore, after passing through a hole in the bone and tensioned, a free end of the cable 120 can be locked and/or crimped to retain the tension in the cable. In some implementations, the pass-through hole 51 extends through two bone segments of a fractured bone such that tensioning the cable 120 to a measurable and adjustable tension in this manner causes the two bone segments to compress together with a measurable and adjustable compression. Moreover, because the cable 120 passes through the bone, as opposed to around the bone, the compression of the two bone segments is applied in one direction (e.g., unidirectionally) concentric with the cable 120, to more uniformly and evenly distribute the compressive load to the bone segments, as opposed to multiple directions when compression is applied by a cable passing around the bone.

As defined herein, a stop is any of various features, such as nuts, clips, conventional washers, pins, balls, caps, lids, or the like, that are attachable to a cable and capable of engaging an opening (e.g., a surface adjacent to or defining the opening) to prevent further passage of the cable through the opening. In one embodiment, the stop 146, shown schematically in FIG. 2C, is spherical or rounded. In another embodiment, the stop 146 resembles a flange or conventional washer, and has a shape that complements the shape of the cable engaging surface 210 of the washer 200 such that the stop 146 is configured to nestably engage the washer 200. According to yet another embodiment, the stop 146 is at least partially deformable to compliment the shape of the cable-engaging surface 210 of the washer 210 as the cable 120 is tensioned.

The stop 146 can be integrated into or permanently attached to a first end portion 123 of the cable 120. For example, the stop 146 may be swaged, crimped, welded, bonded, or otherwise fixedly secured to the cable 120. In another embodiment, the stop 146 can be detachably coupled to the cable 120, thus allowing for stops with different shapes, dimensions, angles, etc. to be alternatively coupled to the same cable as desired.

Referring again to FIG. 2C, after or prior to the cable 120 being passed through the washer 200 and the stop 146 seating on the washer 200, other cables, such as cable 124, 125, can pass through any of the channels or aperture of the washer 200 such that the washer can be used to redirect other cables passing through or around the bone. Alternatively, after passing through the hole in the bone, the cable 120 may wrap around or pass back through the hole in the bone to again engage and be redirected by the washer 200 (e.g., the representations of the cable 124, 125 could be opposing ends of the cable 120 after the cable 120 has passed through the hole in the bone in the direction indicated).

FIG. 2D is a schematic side view of a stop 147 having a cable 127 pre-attached. In one embodiment, the stop 147 has a cross-sectional dimension that is larger than the diameter of the hole 51 in the bone 50, thereby preventing the stop 147 from passing through the hole 51. In one embodiment, the stop 147 is a disk-like stop, analogous to the stop 146 described above. For example, the stop 147 can directly engage the surface of the bone 50 or the stop 147 can be seated in a separate washer that is analogous to the washers described herein. In another embodiment, the stop 147 has features that are analogous to the washers described herein, but with a pre-attached cable 127.

The washer 300 in FIG. 3 has three arms 314A, 314B, 314C extending radially outward from the main body 301 of the washer 300, with three channels 312A, 312B, 312C that all extend along non-parallel axes 313A, 313B, 313C relative to the first axis 307 of the pass-through aperture 306. The bone-engaging surface 303 of the arms 314A, 314B, 314C of the washer 300 may be substantially co-planar with each other but may extend outward away from the pass-through aperture 306 at 90 degrees from each other (thereby leaving 180 degrees between two of the arms 314A, 314B, 314C). In another embodiment, the arms 314A, 314B, 314C are still substantially coplanar but are equally spaced apart in their extension directions (i.e., 120 degrees between adjacent arms). In yet another embodiment, the arms 314A, 314B, 314C are not coplanar, with one arm having a different relative elevation in order to complement the shape of the surface of the bone 50. For example, the arms 314A, 314B, 314C may have different relative vertical elevations and/or the arms 314A, 314B, 314C may be contoured to complement to a specific shape/dimension of a bone.

In another embodiment, four or more arms, each with its own channel, may extend outward away from the main body of the washer, through which the pass-through aperture extends. Alternatively, the washer may include multiple pass-through apertures with multiple arms extending from each pass-through aperture. In other words, the washer may resemble a panel that is configured to span a comparatively larger span of bone surface for a more extensive surgical procedure. In one embodiment, one or more cables may be pre-attached to the washer, as described above with reference to FIG. 2D.

FIG. 4A is a top perspective view of the washer 400, with the groove 412 of the washer being an open groove in the cable-engaging surface 410 extending to a peripheral edge of the washer 400. In such an embodiment, with the cable received within the groove 412, the cable is prevented from moving laterally but is not prevented from slipping out of engagement with the groove 412 if the cable experiences an upward away force, relative to the cable-engaging surface, that moves the cable out of the groove 412.

FIG. 4B is a top perspective view of the washer 450, with a portion 468 of the groove 462 of the washer 450 being circumferentially closed. In such an embodiment, the circumferentially closed portion 468 is a protruding lip extending away from the cable-engaging surface 410. In one embodiment, the circumferentially closed portion 468 of the groove 462 includes a crimping mechanism that enables the cable passing through circumferentially closed portion to be crimped and secured to the washer 450. In one embodiment, the circumferentially closed portion 468 is not disposed near the edge of the washer 450 but instead is disposed comparatively closer to the aperture 406 or alternatively spans the entire length of the groove 462.

FIG. 5 is a schematic flowchart diagram of one embodiment of a method 580 for using the washer to support a cable extending from the bone. The method 580 includes positioning the washer over the hole in the bone such that the bone-engaging surface of the washer engages the surface of the bone adjacent the hole at 581. The method 580 further includes passing the cable through the hole in the bone and through the pass-through aperture in the washer extending along a first axis from the bone engaging surface to a cable-engaging surface at 582. Still further, the method 580 includes positioning the cable in the channel of the washer with the channel extending along a second axis that is at least one of non-parallel to or offset from the first axis at 583.

In one embodiment, positioning the cable in the channel includes passing the cable through a circumferentially closed portion of the channel. In such a configuration, the method 580 further includes crimping the cable in the circumferentially closed portion of the channel. The method 580 also includes tensioning the cable, to a measurable and adjustable tension, after passing the cable through the hole in the bone and after positioning the cable in the channel of the washer at 584, to cause a measurable and adjustable compression of the bone by the cable in some implementations. In one embodiment, the method 580 may further include releasing and re-tensioning the cable to the same or a different measurable and adjustable tension.

FIG. 6 is a schematic flowchart diagram of one embodiment of a method 595 for extending a cable through a pass-through hole in a bone. The method 595 includes passing a cable through the pass-through hole in the bone, with the cable having a stop that is pre-attached at 596. The method 595 further includes tensioning the cable to a measurable and adjustable tension and 597, to cause a measurable and adjustable compression of the bone by the cable in some implementations. In one embodiment, before tensioning the cable, the method 595 further includes positioning a washer over the pass-through hole in the bone so that a bone-engaging surface of the washer engages a surface of the bone adjacent the pass-through hole and passing the cable through a pass-through aperture in the washer extending along a first axis from the bone engaging surface to a cable-engaging surface. The method further may include seating the stop against a complimentary shape of the cable-engaging surface of the washer (e.g. as described above with reference to FIG. 2C). In one implementation, the stop is a washer and the method 595 further includes redirecting one or more additional cables or an opposite end portion of the cable across a cable-engaging surface of the washer.

As mentioned above with reference to method 580, method 595 may optionally include, after the cable is tensioned to a measurable and adjustable tension, releasing the tension in the cable and re-tensioning the cable to the same or different measurable and adjustable tension. Releasing the tension in the cable may include unlocking a lock that is configured to maintain the cable in tension. The ability to release tension in a cable and subsequently re-tension the cable provides various advantages, such as, for example, facilitating re-use of the cable on other targeted areas of the body in one or more subsequent procedures, in some implementations, and adjustment to the tension or position of the cable on the same targeted area of the body in the same or a subsequent procedure, in other implementations.

In the above description, certain terms may be used such as “up,” “down,” “upper,” “lower,” “horizontal,” “vertical,” “left,” “right,” and the like. These terms are used, where applicable, to provide some clarity of description when dealing with relative relationships. But, these terms are not intended to imply absolute relationships, positions, and/or orientations. For example, with respect to an object, an “upper” surface can become a “lower” surface simply by turning the object over. Nevertheless, it is still the same object. Further, the terms “including,” “comprising,” “having,” and variations thereof mean “including but not limited to” unless expressly specified otherwise.

Additionally, instances in this specification where one element is “coupled” to another element can include direct and indirect coupling. Direct coupling can be defined as one element coupled to and in some contact with another element. Indirect coupling can be defined as coupling between two elements not in direct contact with each other, but having one or more additional elements between the coupled elements. Further, as used herein, securing one element to another element can include direct securing and indirect securing. Additionally, as used herein, “adjacent” does not necessarily denote contact. For example, one element can be adjacent another element without being in contact with that element.

As used herein, the phrase “at least one of”, when used with a list of items, means different combinations of one or more of the listed items may be used and only one of the items in the list may be needed. The item may be a particular object, thing, or category. In other words, “at least one of” means any combination of items or number of items may be used from the list, but not all of the items in the list may be required. For example, “at least one of item A, item B, or item C” may mean item A; item A and item B; item B; item A, item B, and item C; or item B and item C; or some other suitable combination. In some cases, “at least one of item A, item B, or item C” may mean, for example, without limitation, two of item A, one of item B, and ten of item C; four of item B and seven of item C; or some other suitable combination.

Unless otherwise indicated, the terms “first,” “second,” etc. are used herein merely as labels, and are not intended to impose ordinal, positional, or hierarchical requirements on the items to which these terms refer. Moreover, reference to, e.g., a “second” item does not require or preclude the existence of, e.g., a “first” or lower-numbered item, and/or, e.g., a “third” or higher-numbered item.

The schematic flow chart diagrams included herein are generally set forth as logical flow chart diagrams. As such, the depicted order and labeled steps are indicative of one embodiment of the presented method. Other steps and methods may be conceived that are equivalent in function, logic, or effect to one or more steps, or portions thereof, of the illustrated method. Additionally, the format and symbols employed are provided to explain the logical steps of the method and are understood not to limit the scope of the method. Although various arrow types and line types may be employed in the flow chart diagrams, they are understood not to limit the scope of the corresponding method. Indeed, some arrows or other connectors may be used to indicate only the logical flow of the method. For instance, an arrow may indicate a waiting or monitoring period of unspecified duration between enumerated steps of the depicted method. Additionally, the order in which a particular method occurs may or may not strictly adhere to the order of the corresponding steps shown.

The subject matter of the present disclosure may be embodied in other specific forms without departing from its spirit or essential characteristics. The described embodiments are to be considered in all respects only as illustrative and not restrictive. The scope of the disclosure is, therefore, indicated by the appended claims rather than by the foregoing description. All changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope. 

What is claimed is:
 1. A washer for supporting through-bone cable extending through a pass-through hole in bone, the washer comprising: a bone-engaging surface; a cable-engaging surface opposing the bone-engaging surface; a pass-through aperture extending through the washer along a first axis from the bone-engaging surface to the cable-engaging surface; and a channel extending from proximate the pass-through aperture along a second axis, wherein the second axis is at least one of non-parallel to or offset from the first axis.
 2. The washer of claim 1, wherein at least a portion of the channel is circumferentially closed.
 3. The washer of claim 1, wherein the washer comprises multiple channels extending from proximate the pass-through aperture along different axes, each axis being at least one of non-parallel to or offset from the first axis.
 4. The washer of claim 1, wherein the washer comprises at least three channels extending from proximate the pass-through aperture in different axes, each axis being at least one of non-parallel to or offset from the first axis.
 5. The washer of claim 1, wherein the pass-through aperture has a substantially non-circular cross-section.
 6. The washer of claim 1, wherein the bone-engaging surface is contoured to complement a contour of a bone.
 7. The washer of claim 1, wherein an angle between the second axis and the first axis is between 45 degrees and 90 degrees.
 8. The washer of claim 1, wherein an angle between the second axis and the first axis is less than 45 degrees.
 9. The washer of claim 1, wherein an angle between the second axis and the first axis is substantially about 30 degrees.
 10. The washer of claim 1, wherein a footprint of the washer is non-circular, the washer further comprising an arm extending outward away from the pass-through aperture, wherein the channel extends from proximate the pass-through aperture through the arm.
 11. The washer of claim 1, wherein the channel forms a continuous circumferentially closed passage from the pass-through aperture and extends to a peripheral edge of the cable-engaging surface.
 12. The washer of claim 1, further comprising a protruding lip at a peripheral edge of the cable-engaging surface, the protruding lip extending away from the cable-engaging surface, wherein the protruding lip circumferentially encloses at least a portion of the channel, thereby retaining the second portion of the cable.
 13. The washer of claim 2, wherein the circumferentially closed portion of the channel is compressible to crimp the cable.
 14. The washer of claim 1, wherein a cable is pre-attached to the washer.
 15. A washer for supporting through-bone cable extending through a pass-through hole in bone, the washer comprising: a bone-engaging surface; a cable-engaging surface opposing the bone-engaging surface; a pass-through aperture extending through the washer along a first axis from the bone-engaging surface to the cable-engaging surface; and a channel extending from proximate the pass-through aperture along a second axis, wherein the second axis is at least one of non-parallel to or offset from the first axis; wherein: a footprint of the washer is non-circular, the washer further comprising an arm extending outward away from the pass-through aperture, wherein the channel extends from proximate the pass-through aperture through the arm; and at least a portion of the channel is circumferentially closed.
 16. The washer of claim 15, wherein an angle between the second axis and the first axis is less than 45 degrees.
 17. The washer of claim 15, wherein an angle between the second axis and the first axis is substantially about 30 degrees.
 18. A method of using a washer to support through-bone cable extending from a pass-through hole in bone, the method comprising: positioning a washer over a hole in a bone such that a bone-engaging surface of the washer engages a surface of the bone adjacent the hole; passing a cable through the hole in the bone and through a pass-through aperture in the washer extending along a first axis from the bone-engaging surface to a cable-engaging surface; and positioning the cable in a channel of the washer, wherein the channel extends along a second axis, wherein the second axis is at least one of non-parallel to or offset from the first axis.
 19. The method of claim 18, wherein positioning the cable in the channel comprises passing the cable through a circumferentially closed portion of the channel.
 20. The method of claim 19, further comprising crimping the cable in the circumferentially closed portion of the channel.
 21. The method of claim 18, further comprising tensioning the cable to a measurable and adjustable tension, to cause a measurable and adjustable compression of the bone by the cable, after passing the cable through the hole in the bone and after positioning the cable in the channel of the washer.
 22. A method of extending a cable through a pass-through hole in bone, the method comprising: passing a cable through the pass-through hole in the bone, wherein the cable is pre-attached to a stop; and tensioning the cable to a measurable and adjustable tension to cause a measurable and adjustable compression of the bone by the cable.
 23. The method of claim 22, wherein the method further comprises: before tensioning the cable, positioning a washer over the pass-through hole in the bone such that a bone-engaging surface of the washer engages a surface of the bone adjacent the pass-through hole; before tensioning the cable, passing the cable through a pass-through aperture in the washer, the pass-through aperture extending from the bone-engaging surface to a cable-engaging surface; and seating the stop against a complimentary shape of the cable-engaging surface of the washer.
 24. The method of claim 22, wherein the stop is a washer and the method further comprises redirecting one or more additional cables or an opposite end portion of the cable along a cable-engaging surface of the washer. 